Track 1, Side 2: Comfortably Numb by Pink Floyd

The immersive experience of stepping into a new world

My dad taught me every epic journey deserves a great soundtrack. My PalliMed Mixtape is the story of my Palliative Medicine Fellowship year, told in 15 songs.

Comfortably Numb on Apple Music

If you drop the needle on Pink Floyd’s Dark Side of the Moon album at the exact moment the MGM lion roars for the first time at the beginning of the 1939 classic film The Wizard of Oz, you will find that the album and the movie line up in wild ways. The lyrics “home, home again” from the song Breathe come just as the fortune teller tells Dorothy to head back home. The song The Great Gig in the Sky provides a perfectly-timed thematic soundtrack for the harrowing tornado scene. The penultimate song Brain Damage plays as the scarecrow laments his plight in If I Only Had a Brain.

(Photo: MGM)

How do I know this? I’ve tried it. My teenage son indulged me late one Friday night this fall after he’d gotten home from a football game. The house was quiet. We streamed The Wizard of Oz with low volume while spinning our copy of Dark Side on the record player. It was fun and ridiculous and thought-provoking and my second favorite Pink Floyd experience.

My first favorite Pink Floyd experience was seeing Roger Waters (Pink Floyd’s lead singer) perform at the Moody Center in 2022 in Austin with an ER doc buddy of mine. We are both long-time fans, had never seen him live, and my buddy surprised me by upgrading our seats on his own dime. The music was immersive, the light show breathtaking, and the friendship life-affirming.

I have always loved Pink Floyd. (And believe it or not, I’ve never done drugs!) In my teenage years I watched an infomercial for a Pink Floyd CD collection that described their music as “pure sonic intoxication,” and I think that phrase might perfectly sum up the Pink Floyd listening experience. I have never felt that it was possible to just casually listen to Pink Floyd—it’s more than that. You experience them. Their music immerses you in their strange waters. It transports you to new worlds—worlds of wonder and promise, worlds of madness and magic, or as they say in the song High Hopes “a world of magnets and miracles.” I knew from the beginning I would want a piece of their music on this mixtape commemorating my journey into a new world.

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Enter Comfortably Numb, the perfect song to start side 2 of this mixtape.

Comfortably Numb’s opening bars are eerie and ominous. These first few measures have always made me feel a little nervous and excited, like I am cautiously stepping into a new place about which I feel very hopeful but very uncertain. The music crescendos quickly toward the first vocal lines of the song, and I find myself quickly swept up and carried away.  The tone at the start of this song exactly mirrors the trepidation I experienced entering our hospice house for the first time—I was entering a strange new world. 

What is a hospice house exactly?  I didn’t really know either. Here’s a brief explanation of what I would soon find out:

Sometimes people on hospice can’t die in their homes.  They may not have all the medical support they need as they get sicker.  They may need IV medications that can’t be given in the home.  Or they may not have a home.  Sometimes these patients need to receive care in a hospice house. 

Now imagine a small hospital, cozy and warm and made to feel like a home, where patients nearing the end of life are treated with medicines to remain comfortable despite their terrible illness.  Families can visit their loved ones here and sleep in the rooms comfortably.  Dogs can visit and even stay.  There are bookshelves and a fireplace in the common spaces.  Music and prayers often fill the rooms and drift out into the hallways.  Windows and doors in patient rooms open onto green spaces and pretty courtyards. 

This is a hospice house, a totally unique space in the world of medicine.

Walking into the hospice house the first time I felt odd physical sensations—a tightness in my chest, butterflies in my stomach, clumsiness in my feet, an unfamiliar nervousness. What would it be like to work in this place where people die all the time?

Hello, hello / Is there anybody in there? / Just nod if you can hear me / Is there anyone at home?

One of the things I first noticed while working in the hospice house was a sense of everything being laid bare, an honesty like I rarely found elsewhere in medicine. These patients are dying.  Soon.  There’s no dressing that up.  This honesty provides clarity, and allows for acceptance and comfort and resolution. In medicine we doctors often have barriers between us and cold, hard facts. Too often we try to protect our patients from tough truths by sugarcoating situations. Our avoidance of honesty often does our patients a disservice.

Not here. Here I found no barriers between us and death, no protections from the reality of our mortality. No teams of rounding residents or surgeons or nurses to insulate and distract us. No diagnostic tests to hide behind, no new treatments to try.  I found, in the face of death, that all my medical training was stripped down to two essential functions—to comfort, and to bear witness.

Even the language here was different. I didn’t hear fancy words like “adenocarcinoma” or “neoadjuvant chemotherapeutic regimen” to make us doctors feel smart and self-assured.  Instead, at the hospice house I learned phrases like like “he’s getting closer,” “she looks so peaceful,” and “hours to days left now.”  These patients have entered a liminal space. They are on their way to elsewhere.

There is no pain, you are receding / A distant ship smoke on the horizon / You are only coming through in waves / Your lips move but I can’t hear what you’re saying

Through my first few shifts I still didn’t know how I would handle myself or if I would have a physiologic or visceral response to being in this space. I reminded myself I needed to bring my A-game to the hospice house in a different way than to any other clinical setting.  The experience here is the final earthly experience.  

Come on now / I hear you’re feeling down / Well I can ease your pain

I didn’t want my patients here to suffer.  I didn’t want my patients to be in pain. I didn’t want families here to struggle with mixed feelings about goals of care. I didn’t want there to be tension or division among patients and caregivers about how things were going.

Mostly I didn’t want any disruptions or invasions into the peacefulness of this hospice house. I didn’t even want my own inner thoughts to invade the space. I wanted, in fact, to empty my mind of extraneous thoughts, of agendas, of all things except slow peaceful palliative thoughts about my patients. No intrusions here—we are standing on holy ground. 

I need to now confess that at times at the hospice house I did entertain some intrusive ER thoughts earlier this year.  I sometimes looked at these transitioning patients and thought about all the things I used to do to resuscitate patients who were this sick.  Could I not turn this patient around with some of my old ER tricks and interventions?

Can you stand up? / I do believe it’s working, good. / That’ll keep you going through the show / Come on, it’s time to go

In the ER those invasive procedures would have done something, been a bridge to the ICU, maybe even a bridge to recovery and survival.  But at the hospice house these thoughts are not consistent with what is best for these patients. These patients have end-stage incurable terminal diseases, and no amount of resuscitation is going to change that.  I sometimes even imagined seeing a bunch of ER-like activity around these patients, a blurry time-lapsed flurry of activity, like some montage in a TV medical drama.  Lots of good-intentioned humans trying desperate things, doing things to “save” the patient—cpr, shocks, central lines, some last heroic doctor moves.

Just a little pinprick / There’ll be no more (aargh!) / But you may feel a little sick. 

Not here.  I honestly think those interventions might not even accomplish anything.  These patients are already too close.  They are on their way, their spirits headed to another realm.  I will admit I’m still processing just exactly what happens in these final moments. I may never fully understand.

Throughout this year I have developed a real comfort with working at the hospice house. It now feels less like the eerie opening chords and more like the glorious guitar solo that ends this song. The hospice house is a world of grace and miracles, of comfort and closure, of sorrow—yes—but also of peace. The incredible staff there is like none I have ever worked with. And the families and patients? What an honor to be at their side during these times. I learn profound things from them all the time.

I hope that the peacefulness we see in our patients’ bodies at the end might reflect where their spirit is, too.  Sometimes I even wonder if our patients are gently trying to reassure us on their way out… you know you don’t have to do anything else for me.  After all, death cannot separate me from the love of God. I’m fine here, friends.  I can’t even feel what you’re doing now.  The cancer can’t hurt me anymore. I’m crossing over, and I’m gonna be ok. And you’ll be ok in time, too.  It’s ok to let me go now.

The child is grown, the dream is gone / I have become comfortably numb.

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Tell me, Crash Cart Campfire friends:

• When have you feared entering a new world at work or otherwise, and how did it go? What helped you in that process?

• Is there a band that you would say you experience, rather than just listen to?